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Biomedical subjects

D Berman

Publications and source records attributed to D Berman.

At least 73 records · Page 4Linked to original sources
PubMed1983

Clinical evaluation of seven-pinhole tomography for the detection and localization of coronary artery disease: comparison with planar imaging using quantitative analysis of myocardial thallium-201 distribution and washout after exercise.

The development of quantitative techniques to assist in the analysis of planar thallium-201 stress-redistribution scintigrams has led to improved abilities of this modality to detect the presence of and to localize significant coronary artery disease (CAD). This fact has encouraged the reevaluation of its capabilities relative to other types of scintigraphic data collection, including seven-pinhole tomography. We have undertaken a comparison of planar scintigraphy and seven-pinhole tomography to detect in 40 exercised patients (23 with angiographically demonstrated CAD, eight with normal coronary angiograms, and nine with less than or equal to 1% likelihood of having CAD) the presence of significant CAD and to localize it correctly to an individual coronary artery. Emphasis was placed on similar imaging conditions and on analysis of images by the same quantitative program of TI-201 distribution and washout. Both techniques were found to be highly sensitive and specific for disease detection and localization. Importantly, seven-pinhole tomography did not significantly improve results.

Coronary Disease↗
PubMed1983

Effects of nitroprusside-induced reduction of elevated preload and afterload on global and regional ventricular function in acute myocardial infarction.

To evaluate the effects of nitroprusside infusion on left and right ventricular ejection fractions and left ventricular regional wall motion, radionuclide ventriculography with simultaneous hemodynamic assessment was performed before and during nitroprusside infusion in 20 patients with acute myocardial infarction complicated by left ventricular failure and/or systemic arterial hypertension. Nitroprusside produced significant reductions in pulmonary capillary wedge pressure (21 +/- 6 to 13 +/- 5 mm Hg; -38%; p less than 0.001), mean arterial pressure (107 +/- 19 to 90 +/- 13 mm Hg; -15.9%; p less than 0.001), left ventricular end-diastolic volume index (84 +/- 28 to 75 +/- 23 ml/m2; -10.7%; p less than 0.001), and right ventricular end-diastolic volume index (77 +/- 30 to 67 +/- 27 ml/m2; -13.0% p less than 0.007), and significant increases in left ventricular ejection fraction (0.32 +/- 0.12 to 0.37 +/- 0.13; +15.6%; p less than 0.0001), right ventricular ejection fraction (0.37 +/- 0.11 to 0.45 +/- 0.14; +21.6%; p less than 0.001), and stroke volume index (25 +/- 7 to 27 +/- 7 ml/beat m2; +8.0%; p less than 0.03). These beneficial changes in global ventricular performance were accompanied by no change in the regional contractile function of 90% of the abnormally contracting infarct-related left ventricular segments and improved regional wall motion of 34% of noninfarcted but abnormally contracting left ventricular segments. We conclude that nitroprusside-induced reduction of elevated preload and afterload in acute myocardial infarction results in salutary effects on global ventricular function and improved regional function of noninfarcted left ventricular segments but with less prominent effects on regional function of infarcted segments.

Adult↗
PubMed1983

Wall motion abnormalities and electrocardiographic changes in acute transmural myocardial infarction: implications of reciprocal ST segment depression.

Left ventricular ejection fraction and regional wall motion were assessed by multigated equilibrium radionuclide ventriculography within 24 hours of onset of first acute transmural myocardial infarction (MI) in 32 patients. Abnormal left ventricular wall motion was noted in all 16 patients with anterior infarction and in 14 of 16 (87.5%) patients with inferior infarction. Regional wall motion abnormalities frequently included areas adjacent to and remote from those predicted by the ECG location of ST elevation and pathologic Q waves. Such remote wall motion abnormalities were associated with reciprocal ST segment depression in 17 of 18 (94%) patients, and conversely reciprocal ST segment depressions were associated with remote wall motion abnormalities in 17 of 24 (71%) patients. The left ventricular ejection fraction was lower in patients with a reciprocal ST segment depression compared to those without (anterior MI 0.29 +/- 0.07 vs 0.43 +/- 0.08, p less than 0.01; inferior MI 0.45 +/- 0.11 vs 0.63 +/- 0.06, p less than 0.001). In addition, the peak MB-CK levels were higher in patients with compared to those without reciprocal ST segment depression (anterior MI 268 +/- 183 vs 102 +/- 60, p less than 0.05; inferior MI 186 +/- 120 vs 67 +/- 20, p less than 0.05). Thirteen of 18 (72%) patients with reciprocal ST segment depression compared to 4 of 13 (31%) patients without reciprocal ST segment depression had a complicated clinical course during their hospital stay. These observation suggest that global left ventricular dysfunction in first acute transmural MI is greater when reciprocal ST segment depression is present on the 12-lead ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Nonsurgical reperfusion in evolving myocardial infarction.

Nonsurgical recanalization of the occluded coronary artery has been performed in patients with evolving myocardial infarction since the late 1970s by intracoronary administration of thrombolytic agents at the ostium of the occluded artery or directly to the site of occlusion. The authors review the basic concepts underlying intracoronary thrombolysis, the method applied at their institution and the clinical results. Reperfusion of totally occluded arteries or termination of the ischemic state in subtotally occluded arteries was achieved in 71 (87.7%) of 81 patients. Reocclusion occurred in four patients, in three of these at a time when anticoagulation became temporarily ineffective, emphasizing the need for uninterrupted anticoagulation with a partial thromboplastin time longer than 80 seconds. Thallium scintigraphic studies before and after reperfusion showed a decrease in defect, indicating myocardial salvage, in the successful cases but not in failures or untreated control subjects. A decrease in thallium-201 defect was followed by improvement of regional wall motion and usually also left ventricular ejection fraction. Three of the patients with an unsuccessful result and one patient with a successful result died. Bypass surgery was performed electively in 18 patients because of multiple vessel involvement. Intracoronary thrombolysis appears to be a relatively safe and promising procedure. A large controlled study will be needed for definitive assessment of its role in the management of acute myocardial infarction.

Adult↗
PubMed1982

Preoperative prediction of reversible myocardial asynergy by postexercise radionuclide ventriculography.

Myocardial asynergy is sometimes reversed by coronary bypass, and a noninvasive method of predicting which assess are reversible would be desirable. To assess whether changes in myocardial wall motion observed immediately after exercise can differentiate reversible from nonreversible myocardial asynergy, we evaluated 53 patients by radionuclide ventriculography before and after exercise and again at rest after coronary bypass surgery. Preoperative improvement in wall motion immediately after exercise was highly predictive of the surgical outcome (average chance-corrected agreement, 91 per cent). At surgery the asynergic segments that had improved after exercise were free of grossly apparent epicardial scarring. The accuracy of these predictions for postoperative improvement was significantly greater (P less than 0.01) than that of analysis of Q waves on resting electrocardiography (average chance-corrected agreement, 40 per cent). In contrast, preoperative changes in left ventricular ejection fraction after exercise were not predictive of postoperative resting ejection fraction. We conclude that postexercise radionuclide ventriculography can be used to identify reversible resting myocardial asynergy. This test should prove effective in predicting which patients with myocardial asynergy are most likely to benefit from aortocoronary revascularization.

Adult↗
PubMed1982

Effect of a new 5 alpha-reductase inhibitor on size, histologic characteristics, and androgen concentrations of the canine prostate.

Mature male beagles were used in studies designed to determine the effect of the steroidal 5 alpha-reductase inhibitor 17 beta-N,N-diethylcarbamoyl-4-aza-4-methyl-5 alpha-androstan-3-one (4-MA) on size, histology, and androgen concentration of the prostate. Subcutaneous administration of 3 or 15 mg/kg/day for 43 days caused a sharp decline in prostate volume. flattening of prostatic epithelial cells, vacuolization of the cytoplasm and pycnosis of the nuclei. Whereas serum testosterone levels remained normal in dogs injected with 3 mg/kg/day, they were lower in those that received 15 mg/kg/day. Concentration of both testosterone and 5 alpha-dihydrotestosterone were reduced in the prostates of dogs that had received either 3 or 15 mg/kg/day of 4-MA. The 15 mg/kg/day level also appeared to adversely affect spermatogenesis. In a 43-day study, 4-MA given orally once each day at levels of 0.1, 0.3, or 1 mg/kg failed to cause a significant decrease in prostate volume. However, daily divided oral doses totaling 1 or 3 mg/kg were given in a 42-day test and both treatment levels produced significant reductions in prostate size.

5-alpha Reductase Inhibitors↗
PubMed1982

A method for concentrating viruses recovered from sewage sludges.

Buffered 10% beef extract eluates of primary, activated, and anaerobic mesophilically digested sludges were concentrated 20-fold by the Katzenelson organic flocculation procedure after diluting the beef extract in the eluates to a final concentration of 3%. The weighted mean recovery of virions from the concentrates was approximately 58% of the numbers present in the unconcentrated buffered 10% beef extract eluates. Flocculation of eluates that contained buffered 10% beef extract at times produced poor flocs. Application of the Katzenelson procedure to the diluted buffered 10% beef extract procedure for recovering virions from sludges permits an economy in the number of cell cultures required for assays of virions in beef extract eluates that is necessary in most laboratories.

Animals↗
PubMed1982

Right atrial tamponade complicating cardiac operation: clinical, hemodynamic, and scintigraphic correlates.

Persistent bleeding into the pericardial space in the early hours after cardiac operation not uncommonly results in cardiac tamponade. Single chamber tamponade also might be expected, since in this setting the pericardium frequently contains firm blood clots localized to the area of active bleeding. However, this complication has received very little attention in the surgical literature. We are therefore providing documentation that isolated right atrial tamponade can occur as a complication of cardiac operation and that there exists a potential for misdiagnosis and hence incorrect treatment of this condition. Right atrial tamponade may be recognized by a combination of low cardiac output, low blood pressure, prominent neck veins, right atrial pressure in excess of pulmonary capillary wedge pressure and right ventricular end-diastolic pressure, and a poor response to plasma volume expansion. Findings on chest roentgenogram and gated wall motion scintigraphy may be highly suggestive. This review should serve to increase awareness of this complication and to provide some helpful diagnostic clues.

Bioprosthesis↗
PubMed1981

Real time computerization of two-dimensional echocardiography.

A computerized system was developed for real time acquisition, enhanced processing, analysis, and display of cross-sectional images of the left ventricle derived by two-dimensional echocardiography (2DE). The new methodology couples a standard medical imaging computer system to the video output of any current 2DE unit, uses a 128 x 128 or 64 x 64 matrix window and stores the real time 30 frames/sec digitized images on a magnetic disk. Computerized beat-to-beat and frame-by-frame processing employs space-time smoothing the automatic detection of endocardial interfaces by standard threshold and second derivative techniques. Multiple views are displayed in real time with 256 levels of gray and color. The methodology was used to analyze and graphically display frame-by-frame changes throughout the cardiac cycle. In addition, regional wall motion and thickness were analyzed in 12 sectors of individual cross-sections using a standardized angular subdivision originating at the center of area and indexed by an external reference point. An algorithm was developed to correct cross-sectional interference definition from the commonly used trailing-to-leading edge to the more valid leading-to-leading outline technique. Computerized analysis of spatial and temporal variations of cardiac contraction were demonstrated in several clinical and experimental applications, including bicycle exercise testing, investigation of acute myocardial infarction, and assessment of interventions. Initial evaluation indicates that the new real time computerized digital acquisition and data analysis represents a major advances toward quantitation of left ventricular function using 2DE.

Animals↗
PubMed1981

Intracoronary thrombolysis in acute myocardial infarction: experimental background and clinical experience.

Occlusive intracoronary (IC) thrombosis was produced experimentally in dogs by placement of a copper coil. The thrombus was consistently lysed by application of Thrombolysin (streptokinase and plasminogen) at the site of occlusion, 1 to 6 hours after thrombosis. Thrombolysin has no toxic effect on the coronary artery wall or the myocardium. Reperfusion after 30 to 60 minutes of occlusion frequently resulted in ventricular fibrillation, but gradual reperfusion reduced the probability of ventricular fibrillation. Intramyocardial bleeding was noted after reperfusion in areas of advanced necrosis and was shown to be the consequence, rather than the cause, of necrosis. The reperfused myocardium remained hypocontractile, but in contrast to the occlusion period, its mechanical function could be enhanced by inotropic stimulation. After experimental studies confirmed the feasibility and safety of IC thrombolysis, the technique was applied within 3 hours of onset of pain in 29 patients with evolving acute myocardial infarction (AMI) and showing ST elevations without pathologic Q waves. Nitroglycerin (NTG), 0.1 mg, was injected into the occluded coronary artery to rule out spasm; NTG failed to open the occluded artery. A special, very flexible, radiopaque No. 2 French catheter was advanced through the angiography catheter to the site of occlusion. Thrombolysin was infused at a rate of 4000 to 6000 IU/min until patency was achieved, followed by 2000 IU/min for 60 minutes. Lysis of clot was achieved in 27 of 29 patients. The single death (unrelated to the procedure) occurred subsequently in a patient in whom the artery was not reopened. After successful thrombolysis, 12 patients underwent elective coronary bypass surgery because of multiple stenoses. The need for early reperfusion is emphasized for effective IC thrombolysis therapy in evolving AMI.

Animals↗
PubMed1981

A method for recovering viruses from sludges.

Primary, activated, and anaerobic mesophilically digested sludges were salted with MgCl2 (divalent cations) or AlCl3 (trivalent cations) and acidified to bind indigenous unadsorbed virions to the sludge solids; the sludges were centrifuged, and the adsorbed virions were eluted from the solids with buffered 10% beef extract. The elution yields with this procedure were superior to those obtained from sludges that had been salted or acidified only. Homogenization of sludges prior to other treatment did not increase the numbers of virions recovered.

Aluminum↗